Abstract

To evaluate the safety of direct oral anticoagulants (DOACs) versus low-molecular weight heparin (LMWH) in patients with central nervous system (CNS) malignancies and secondary metastases. All adult patients with CNS malignancies and secondary metastases who were treated with a DOAC or LMWH for any indication from 2018 to 2022 were included. The primary outcome was the incidence of any intracranial hemorrhage (ICH) after anticoagulation initiation. Secondary outcomes included non-ICH bleeding events and thromboembolic events. Tolerability was assessed by any changes in anticoagulant therapy during study period. 153 patients were included; 48 patients received enoxaparin and 105 received DOACs, of which apixaban was used most commonly. The population was predominantly White (74%) and male (59%) with a median age of 65. Data was censored for immortal time bias for outcomes evaluated beyond 3 months. ICH occurred in 7.7% of the population, more frequently in the enoxaparin group (DOACs 4, 4% vs. enoxaparin 7, 16%, p = 0.037). Non-ICH bleeds were predominantly minor and more common in the DOAC group (DOACs 13, 13% vs. enoxaparin 1, 2%, p = 0.037). Thromboembolic events were not different between groups (DOACs 9. 9% vs, enoxaparin 2, 4%, p = 0.503). Anticoagulant switches occurred more in the enoxaparin group (DOACs 12, 12.4% vs. enoxaparin, 37.8%, p < 0.001), primarily due to patient or provider preference. Our data supports DOACs to be preferred over LMWH for the treatment of VTE or for stroke prevention with AF to prevent ICH in patients with brain tumors or metastases.

中文翻译：

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原发性中枢神经系统恶性肿瘤和继发性转移患者的抗凝处方模式

摘要

评估直接口服抗凝剂（DOAC）与低分子量肝素（LMWH）在中枢神经系统（CNS）恶性肿瘤和继发转移患者中的安全性。纳入 2018 年至 2022 年期间因任何适应症接受 DOAC 或 LMWH 治疗的所有患有 CNS 恶性肿瘤和继发转移的成年患者。主要结局是开始抗凝治疗后颅内出血（ICH）的发生率。次要结局包括非 ICH 出血事件和血栓栓塞事件。通过研究期间抗凝治疗的任何变化来评估耐受性。纳入153名患者；48 名患者接受依诺肝素治疗，105 名患者接受 DOAC，其中最常用的是阿哌沙班。人口主要为白人 (74%) 和男性 (59%)，中位年龄为 65 岁。对超过 3 个月评估结果的不朽时间偏差进行数据审查。7.7% 的人群发生 ICH，依诺肝素组发生率更高（DOAC 4, 4% vs. 依诺肝素 7, 16%，p = 0.037）。非 ICH 出血主要是轻微的，并且在 DOAC 组中更为常见（DOAC 13, 13% vs. 依诺肝素 1, 2%，p = 0.037）。组间血栓栓塞事件没有差异（DOAC 9. 9% vs 依诺肝素 2, 4%，p = 0.503）。依诺肝素组的抗凝转换发生率更高（DOAC 12，12.4% vs 依诺肝素组，37.8%，p < 0.001），这主要是由于患者或医疗服务提供者的偏好。我们的数据支持 DOAC 优于 LMWH，用于治疗 VTE 或预防 AF 卒中，以预防脑肿瘤或转移患者的 ICH。